Chronic orthostatic hypotension (OH) is frequently a severely debilitating disease that affects large groups of the population with autonomic insufficiency--the elderly; patients with diabetes, Parkinson's disease, and chronic fatigue syndrome; and anyone on drugs that affect the autonomic nervous system. Unfortunately, even though more than 60 medications are currently being used to treat OH, none of them is particularly or consistently effective. Ruscus aculeatus, a phytotherapeutic agent that is well known in Europe, may, however, change this. Its vasoconstrictive and venotonic properties make it ideally suited to treat the pooling of blood in the limbs, lack of venous tone, and lack of neurally mediated vasoconstriction that frequently characterize OH. Although it has never been suggested as a treatment for OH, it already has a long, proven record of use in Europe for treating a variety of circulatory disorders.
OBJECTIVE:

To provide evidence for what appears to be an effective, safe, inexpensive botanical therapy for OH and encourage further studies on the efficacy of Ruscus for OH patients.
DESIGN:

Review of OH and therapies currently available for OH and evaluation of the properties of Ruscus aculeatus, its mechanism of action, and its suitability as a therapeutic agent for treatment of OH.
RESULTS:

A review of the many pharmacologic and nonpharmacologic agents for treating OH reveals that all of the drug therapies are disappointing and marginally useful. Although nonpharmacologic management is preferred, in the many cases in which OH becomes debilitating, pharmacologic intervention becomes a last resort. But drug therapy may not always be necessary, because Ruscus aculeatus, a phytotherapeutic agent containing ruscogenins and flavonoids, may prove useful for the treatment of OH if denervation is not so advanced that it has compromised receptor activity at the venous wall. Ruscus aculeatus is an alpha-adrenergic agonist that causes venous constriction by directly activating postjunctional alpha1- and alpha2-receptors, in turn stimulating the release of noradrenaline at the level of the vascular wall. It also possesses venotonic properties: it reduces venous capacity and pooling of blood in the legs and exerts protective effects on capillaries, the vascular endothelium, and smooth muscle. Its flavonoid content strengthens blood vessels, reduces capillary fragility, and helps maintain healthy circulation. Unlike most of the drug therapies used to treat OH, Ruscus aculeatus does not cause supine hypertension. It also appears to do something no other therapy can offer--alleviate the worsening effects of OH in environmentally hot conditions. Finally, it is an extremely safe, inexpensive, over-the-counter botanical medicine.
CONCLUSION:

With proven phlebotherapeutic properties, including vasoconstrictive action and venotonic properties, Ruscus aculeatus shows great promise for ameliorating the symptoms of OH and improving the quality of life for large groups in the population. It clearly deserves to be the object of wider research and study as a treatment for OH.

I've taken both it and midodrine. Midodrine had a very noticeable effect (though lots of side-effects for me) but I didn't notice anything from Butchers's Broom--the I may not have been taking a large enough dose.

I've taken both it and midodrine. Midodrine had a very noticeable effect (though lots of side-effects for me) but I didn't notice anything from Butchers's Broom--the I may not have been taking a large enough dose.

Interesting - I have OI but have been resisting the idea of trying midrodine, beta-blockers, etc. until I'd exhausted some other options (such as the methylation protocol). I've been concerned about some of the severe side-effects that some people get, and supine hypertension.

Butcher's broom sounds interesting but I always feel sceptical about statements that herbal preparations are safe - they haven't always undergone the kind of clinical or safety trials that would provide evidence to back up the statement and there seems to be often a default belief that natural remedies must be safe simply because they're natural. (I'm not referring to the beliefs of anyone on this thread - no one here is saying anything like that!).

I can't see the full paper - is there any data in it on safety? Particularly on safety of people with the different varieties of OI (which I'm assuming is what they mean by OH) such as low-flow POTS, high-flow POTS, and NMH?

A plant in the lily family, Butcher's broom (Ruscus aculeatus) is also known as box holly or knee holly. It contains ruscogenins, constituents believed to strengthen collagen in blood vessel walls and improve circulation. This is thought to tighten weak, stretched vessels such as those associated with varicose veins.

Side effects of butcher's broom may include digestive complaints such as indigestion or nausea. People with high blood pressure or benign prostate hyperplasia should not take butcher's broom without first consulting a doctor. The safety of butcher's broom in pregnant or nursing women or children has not been established.

Butcher's broom should not be taken with medication for high blood pressure, benign prostate hyperplasia, or MAO inhibitors unless under medical supervision."

Since the paper was written before the delineation of POTS into low/normal/high flow but one of the research groups there will be no mention of this. There is information of the safety and efficacy through references to european reviews in the paper.

Infact the paper specifically only talks about conditions of neurally mediated hypotension. However its action in vasoconstriction via alpha 1 receptors is similar to vasopressors commonly used in POTS although it also has an alpha 2 action similar to clonidine.

I've been looking at sources of butchers broom on the net (apparently the plant used to be used to make brooms for butchers!). There's a reviewer on US Amazon who has posted on lots of different butchers broom preparations to say that you need a standardardised product containing ruscogenin (here's the review of the favoured product - the reviewer claims to have no financial interest).

Does anyone have any views on the respective formulations, what would be a reasonable dose, how long to expect before seeing an effect on OI, etc.? All the Amazon comments seem to be about its effectiveness for haemorrhoids! One guy said it literally saved his behind.

Interesting that it's supposed to strengthen blood vessel walls. I have only recently stopped getting extensive burst blood vessels in my eyes when I sneeze hard, possibly because I've been taking Vit C for the past six months. It didn't occur to me that the same problem might underlie my OI.

"Butcher's broom may lessen orthostatic hypotension in some patients (Redman, 2000). Studies show that butcher's broom does not cause supine hypertension and that it can alleviate the worsening of symptoms in hot environments. Butcher's broom is a vasoconstrictor that reduces capillary permeability. Butcher's broom has been used as a diuretic, so patient's need to be especially cautious about taking it. Butcher's broom should only be taken under a doctor's supervision. "

The Redman study of course is the one we're discussing in this thread.

Well I've ordered some, Nature's Way Butchers Broom root. Will experiment with dosage and monitor my bp and other symptoms. It would be nice to have a doctor's or naturopath's help but I don't have
this level of care or expertise in the treatment of most of my symptoms, anymore than with the overall condition of ME.

I was reading up on Butchers Broom and came across a paper warning against using it with alpha blockers and MAOIs. I use Pregabalin (Lyrica) and have started a thread to see if anyone can tell me whether it's actually an alpha blocker (please post there if you know!) but just thought I'd pass on the heads-up.

In my one week experiment, so far, so not so helpful. Using it alone, without the morning dose of Midodrine, two capsules as noted on the bottle for a daily dose, did not help my low blood pressure. I could feel a slight effect from it. Maybe it is as if the Butchers Broom is turning a switch but in my case the switch no longer connects to the right place. I am getting ahead of my results, though. So I tried it with Midodrine, either one capsule or two or three. With the three, it was clear I was feeling anxious, which I almost never do--anxious in a sustained way. I could feel a slighter version of this with two capsules in addition to the Midodrine, and barely a touch of it--no problem--at one. So that is why I am indicating that there is a certain revving effect---but for me, this doesn't lead to a restoration of a good blood pressure when standing or walking. So, I am disappointed.